Premenstrual syndrome

Definition

Start during the second half of the menstrual cycle (14 days or more after the first day of your last menstrual period)

Go away 1 - 2 days after the menstrual period starts

Alternative Names

PMS; Premenstrual dysphoric disorder

Causes, incidence, and risk factors

The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.

PMS may be related to social, cultural, biological, and psychological factors.

Up to 3 out of every 4 women experience PMS symptoms during their childbearing years. It occurs more often in women:

Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others

Loss of sex drive (may be increased in some women)

Mood swings

Poor judgment

Poor self-image, feelings of guilt, or increased fears

Sleep problems (sleeping too much or too little)

Signs and tests

There are no specific signs or lab tests that can diagnose PMS. To rule out other possible causes of symptoms, it is important to have a:

Complete medical history

Physical exam (including pelvic exam)

A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.

Treatment

Keep a daily diary or log for at least 3 months. Record the type of symptoms you have, how severe they are, and how long they last. This symptom diary will help you and your health care provider find the best treatment.

A healthy lifestyle is the first step to managing PMS. For many women, lifestyle approaches are often enough to control symptoms.

Drink plenty of fluids (water or juice, not soft drinks, alcohol, or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms.

Eat frequent, small meals. Leave no more than 3 hours between snacks, and avoid overeating.

Eat a balanced diet with extra whole grains, vegetables, and fruit, and less or no salt and sugar.

Your health care provider may recommend that you take nutritional supplements. Vitamin B6, calcium, and magnesium are commonly used. Tryptophan, which is found in dairy products, may also be helpful.

Get regular aerobic exercise throughout the month to help reduce the severity of PMS symptoms.

In severe cases, medicines to treat depression may be helpful. Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often tried first. You can reduce the need for medicines by using: